HomeMy WebLinkAboutPermit Electrical 1997-10-10
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225 FIrlifhSmEfinature rJ ~ "'~<<, {:> ~LECTRICAL PERMIT APPLICATION
SPRINGFIELD, OREGON 97477 ~~ # (\~ r./ a
INSPECTION REQUEST: 726-3769 .B.~ ~t/f ~$:) <(City Job Number '7 j / /57
OFFICE: 726-3759 <<,'T"'.~ ~.....
~ 1Y ~LETE FEE SCHEDULE BELOII
1. LOCATION OF INSTALWION ~. ~ <::,~ ~<<,((:. ~'f-
~/'::?6 .-c;;,r<;,(~A;A~~{J _<>,'*' ~-0~ f0-1p. ~e~ ~esid7ntial-single.or
(/ - ~v <?V ~<<,v 0 if)\1!ul tl-Famlly per d~elhng uni t.
LEGAL DESCRIPTION "'~<::, ~O<('. ~v~ ~<<,<('. Service Included:
\{:\ .,<c."" "'~ Items Cost Sum
r ~'- r;;:;v
JOB DESCj.IPTION va.s\ ,'8
IUu~ ..AouS' c;... ~~ uA-"')rCo
v
Permi ts are non-transferab,le .and expire
if ~ork is not started ~ithin 180 days
. of issuance or if ~ork is suspended for
180 days.
2. CONTRACTOR INSTALLATION ONLY .B.
Electrical Contractor~\"~\1~j~~
Address PD, &'l. 1~3.;l3
Ci ty go l~ V'n .Phone .fx:2.,-/1R/i-J./8'1Q
Supervisor License Number 2:{ :?'? -;0,_
Expiration Date J()-I -qg
Constr Contr. Number ()~o5q3
1000 sq.ft. or less ) $ 85.00
Each additional 500
sq. ft or portion /
thereof $ 15.00
Each Manuf'd Home. or
ModularDllelling
Service or Feeder S 40.00
Services or Feeders ,
Installation, Alterations
or Relocation:
200 amps or less
201 amps to 400 amps
401 amps to, 600 amps
601 amps to 1000 amps
Over 1000 amps/volts
Reconnect Only
$ 50.00
S 60.00
$100.00
$130.00
$300.00
$ 40.00
C. Temporary Services or Feeders
Installation, Alteration or Relocation
Expiration Date
;;'-/~-qq
Signature of Supervising Electrician
~L~#c?2A6/
Ollners Name~' \1"Hol'Vu~ ~
Address 'RCI ::;, ~ciflc. Au)", LB.() rsnx LJSl
'-'
City YV11ll'1vuau:1-h Phone .t:)()?-,-R~'iS-OOCjIo
01lNER INSTALLATION
The'installation is being made on
property I Olin IIhich is not intended
for sale, lease or rent.
Ovners Signature:
---------------------------------------
DATE: Ib -/0 - '7 7
RECEIPT 11: ;}7&4- '7
b"~"T,,,.,n tJv. K'w
200 amps'.OY less,
201 amps to 400 amps
Over 401 to 600 amps
,Over 600 'amps or 1000, volts
D.
Branch Circui ts
$ 40.00
S 55.00
S 80.00
see.~ uBu above
"
Ne~. Alteration or Extension Per Panel
One Circu'i t
Each Addi tional
Circuit or ~ith Service
or Feeder Permit
$ 35.00
$ 2.00
no t included)
Miscellaneous (Service/feeder
-Each installation
. Pump or i rriga t ion'
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
E.
5. SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
'I'O'l'A1.
S 40.00
$ 40.00
$ 20.00
$ 36.00
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